Healthcare Provider Details

I. General information

NPI: 1548420227
Provider Name (Legal Business Name): ANTHONY P. ANNESE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/16/2008
Last Update Date: 10/10/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 W SAMPLE ROAD SUITE 204
POMPANO BEACH FL
33064-3547
US

IV. Provider business mailing address

1608 SE 3RD AVENUE THIRD FLOOR PBO
FORT LAUDERDALE FL
33316-2564
US

V. Phone/Fax

Practice location:
  • Phone: 954-785-0300
  • Fax: 954-785-0229
Mailing address:
  • Phone: 954-785-0300
  • Fax: 954-785-0229

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number237076
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number56797
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: